Lung Transplantation in the United States for COVID-19 Related Lung Disease During the Pandemic.

IF 4.6 2区医学 Q1 RESPIRATORY SYSTEM Lung Pub Date : 2024-06-27 DOI:10.1007/s00408-024-00724-z

Mikayla D'Cunha, J Asher Jenkins, Renita Wilson, Juan Maria Farina, Ashraf Omar, Blake Langlais, Cecilia Benz, Jonathan D'Cunha, Pedro Augusto Reck Dos Santos

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Abstract

Purpose: Lung transplantation (LTx) is a potential intervention for end-stage COVID-19 lung disease. Current literature is sparse regarding the outcomes of LTx for COVID-19 related acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF). This study aims to characterize outcomes and patterns of LTx for COVID-19 related lung disease throughout the pandemic.

Methods: Patients who underwent LTx during the pandemic for COVID-19 related lung disease were retrospectively identified using the UNOS registry. Demographics, as well as outcomes measures and nationwide patterns of care were collected and analyzed.

Results: A total of 510 adult cases of LTx for COVID-19 (259 ARDS, 251 PF) were compared to 4,031 without COVID-19 (3,994 PF, 37 ARDS). Patients who received LTx for COVID-19 ARDS did not differ in 2-year survival when compared to those with COVID-19 PF (81.9% vs 77.2%, p = 0.4428). Compared to non-COVID-19 etiologies, COVID-19 ARDS patients had higher rates of stroke (2.3% vs 0%, p = 0.0005), lower rates of graft failure (12.8% vs 36.1%, p = 0.0003) and post-transplant ECMO (29.6% vs 41.7%, p = 0.0002), and improved 2-year survival following LTx (81.9% vs 61.7%, p = 0.0064). No difference in 2-year survival following LTx was observed between patients with COVID-19 and non-COVID-19 PF (77.2% vs 71.8%, p = 0.34). Rates of LTx spiked with variant emergence and declined with rounds of vaccination.

Conclusion: Our results are consistent with early reports of survival outcomes following LTx for COVID-19 ARDS and PF while providing an increased layer of granularity. LTx may be considered as a safe and effective intervention for COVID-19 lung disease.

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美国在大流行期间为治疗 COVID-19 相关肺病而进行的肺移植手术（2597/2600）。

目的：肺移植（LTx）是治疗 COVID-19 终末期肺病的一种潜在干预措施。目前有关 LTx 治疗与 COVID-19 相关的急性呼吸窘迫综合征（ARDS）和肺纤维化（PF）的结果的文献很少。本研究旨在描述整个大流行期间与 COVID-19 相关的肺部疾病的 LTx 治疗结果和模式：方法：利用 UNOS 登记系统对大流行期间因 COVID-19 相关肺部疾病而接受 LTx 治疗的患者进行回顾性鉴定。收集并分析了患者的人口统计学特征、治疗效果和全国范围内的治疗模式：结果：共有 510 例因 COVID-19 而接受低温治疗的成人病例（259 例 ARDS、251 例 PF）与 4031 例未接受 COVID-19 治疗的病例（3994 例 PF、37 例 ARDS）进行了比较。与COVID-19 PF患者相比，因COVID-19 ARDS而接受LTx治疗的患者在2年生存率上没有差异（81.9% vs 77.2%，P = 0.4428）。与非COVID-19病因的患者相比，COVID-19 ARDS患者的卒中发生率更高（2.3% vs 0%，p = 0.0005），移植失败率（12.8% vs 36.1%，p = 0.0003）和移植后ECMO发生率（29.6% vs 41.7%，p = 0.0002）更低，LTx后的2年生存率更高（81.9% vs 61.7%，p = 0.0064）。COVID-19和非COVID-19 PF患者的LTx术后2年生存率没有差异（77.2% vs 71.8%，p = 0.34）。LTx率随着变异体的出现而激增，并随着一轮疫苗接种而下降：结论：我们的研究结果与早期关于COVID-19 ARDS和PF的LTx后存活结果的报道一致，同时提供了更多的细节。LTx可被视为治疗COVID-19肺病的一种安全有效的干预措施。

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来源期刊

Lung 医学-呼吸系统

CiteScore

9.10

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.